Report of the APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation

The task force conducted a systematic review of the peer-reviewed journal literature on sexual orientation change efforts (SOCE) and concluded that efforts to change sexual orientation are unlikely to be successful and involve some risk of harm, contrary to the claims of SOCE practitioners and advocates.

Even though the research and clinical literature demonstrate that same-sex sexual and romantic attractions, feelings and behaviors are normal and positive variations of human sexuality, regardless of sexual orientation identity, the task force concluded that the population that undergoes SOCE tends to have strongly conservative religious views that lead them to seek to change their sexual orientation.

Thus, the appropriate application of affirmative therapeutic interventions for those who seek SOCE involves therapist acceptance, support and understanding of clients and the facilitation of clients’ active coping, social support and identity exploration and development, without imposing a specific sexual orientation identity outcome.

The appropriate application of affirmative therapeutic interventions for children and adolescents who present a desire to change either their sexual orientation or their behavioral expression of their sexual orientation, or both, or whose guardian expresses a desire for the minor to change.

The appropriate application of affirmative therapeutic interventions for adults who present a desire to change their sexual orientation or their behavioral expression of their sexual orientation, or both.

The presence of adolescent inpatient facilities that offer coercive treatment designed to change sexual orientation or the behavioral expression of sexual orientation.

Education, training and research issues as they pertain to such therapeutic interventions.

Recommendations regarding treatment protocols that promote stereotyped gender-normative behavior to mitigate behaviors that are perceived to be indicators that a child will develop a homosexual orientation in adolescence and adulthood.

3. Inform APA’s response to groups that promote treatments to change sexual orientation or its behavioral expression and support public policy that furthers affirmative therapeutic interventions.

As part of the fulfillment of its charge, the task force undertook an extensive review of the recent literature on psychotherapy and the psychology of sexual orientation. There is a growing body of evidence concluding that sexual stigma, manifested as prejudice and discrimination directed at non-heterosexual sexual orientations and identities, is a major source of stress for sexual minorities. This stress, known as minority stress, is a factor in mental health disparities found in some sexual minorities. The minority stress model also provides a framework for considering psychotherapy with sexual minorities, including understanding stress, distress, coping, resilience, and recovery. For instance, the affirmative approach to psychotherapy grew out of an awareness that sexual minorities benefit when the sexual stigma they experience is addressed in psychotherapy with interventions that reduce and counter internalized stigma and increase active coping.

The task force, in recognition of human diversity, conceptualized affirmative interventions within the domain of cultural competence, consistent with general multicultural approaches that acknowledge the importance of age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language and socioeconomic status. We see this multiculturally competent and affirmative approach as grounded in an acceptance of the following scientific facts:

Same-sex sexual attractions, behavior and orientations per se are normal and positive variants of human sexuality — in other words, they do not indicate either mental or developmental disorders.

Homosexuality and bisexuality are stigmatized, and this stigma can have a variety of negative consequences (e.g., minority stress) throughout the life span.

Same-sex sexual attractions and behavior occur in the context of a variety of sexual orientations and sexual orientation identities, and for some, sexual orientation identity (i.e., individual or group membership and affiliation, self-labeling) is fluid or has an indefinite outcome.

Gay men, lesbians and bisexual individuals form stable, committed relationships and families that are equivalent to heterosexual relationships and families in essential respects.

Some individuals choose to live their lives in accordance with personal or religious values (e.g., telic congruence).

Note. We use the term sexual minority (cf. Blumenfeld, 1992; McCarn & Fassinger, 1996; Ullerstam, 1966) to designate the entire group of individuals who experience significant erotic and romantic attractions to adult members of their own sex, including those who experience attractions to members of both their own and the other sex. This term is used because we recognize that not all sexual minority individuals adopt a lesbian, gay, or bisexual identity.

This intermediate workshop aims to implement aspects of the 2009 Report of the APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation. After a brief review of the report, the workshop focuses on the recommended framework for affirmative therapeutic practice with adults seeking sexual orientation change. Emphasis is on the ethical and science-based integration of religious and sexual orientation identities in religiously conflicted clients. A video and a demonstration illustrate applications.

The workshop was developed by Kathleen Ritter, PhD, and Timothy R. Moragne, PsyD, and was offered as a continuing education workshop at the 2012 APA Annual Convention. The APA Education Directorate's Continuing Professional Education Department recorded the workshop and packaged it as this online continuing education program. The program consists of the presenter recording with synchronized presentation slides.